Remote RN Care Manager — Chronic Care & Transitions

McLaren Health Care; Flint (MI); Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Full-time schedule

8:00am–5:00pm shifts

Remote work option

Job summary

McLaren Health Care in Michigan seeks a Care Coordinator Registered Nurse to support patients remotely. You will assess, plan, implement, coordinate, monitor, and evaluate care needs using clinical and community resources to promote quality outcomes.

You will work within an interdisciplinary team to prevent hospitalizations and ER visits. The role emphasizes care coordination for chronically ill populations, with required Michigan RN licensure and 3+ years of clinical nursing experience.

Qualifications

• RN with a valid unrestricted Michigan license.
• Three years of clinical nursing experience serving chronically ill patients.
• Preferred: RN, BSN; three years in health plan/ Physician Organization with care coordination or population health.

Responsibilities

• Provides telephonic and face-to-face comprehensive assessment and care management services as part of an interdisciplinary team.
• Uses risk assessment tools to target high-risk populations.
• Assesses ongoing health, educational, and psychosocial needs of patient/caregiver.
• Follows up after transitions, coordinates care, and educates on discharge instructions.
• Uses clinical judgment to determine level of care and collaborate with PCP and team.
• Develops individualized care plans and revises as needed.
• Supports patient self-management to empower self-care.
• Monitors high-risk patients to prevent acute episodes.
• Implements protocols based on guidelines and risk stratification.
• Coordinates care with PCP, patient/caregiver, McLaren Health Care, and community services.
• Fosters team-based care with patient involvement.
• Ensures continuity of care beyond practice boundaries.
• Acts as liaison to hospitals, specialists, and post-acute services.
• Maintains documentation of care management activities.
• Works with leadership to evaluate processes and drive improvements.
• Keeps up with literature on engagement and care management strategies.
• Performs other duties to maintain department operations.

Skills

Care coordination

Telephonic care management

Geriatrics experience

Chronic disease management

Patient advocacy

Education

RN License

BSN (preferred)

Job description

McLaren Health Care in Michigan seeks a Care Coordinator Registered Nurse to support patients remotely. You will assess, plan, implement, coordinate, monitor, and evaluate care needs using clinical and community resources to promote quality outcomes.

You will work within an interdisciplinary team to prevent hospitalizations and ER visits. The role emphasizes care coordination for chronically ill populations, with required Michigan RN licensure and 3+ years of clinical nursing experience.